Showing papers in "The Japanese journal of thoracic diseases in 1993"
TL;DR: It is concluded that OSAS patients have the tendency of daytime sleepiness and high traffic accidents rates, and NCPAP treatment is effective to improve such problems.
Abstract: We studied the traffic accident rates and daytime sleepiness in obstructive sleep apnea syndrome (OSAS) patient, and evaluated the effectiveness of long-term nasal CPAP treatment. Traffic accidents were observed in 42% of 14 male OSAS patients (46 +/- 7 years old) and near-miss accidents were also observed in 64% during the past three years. Stanford Sleepiness Scale showed 4.7 +/- 1.0, suggesting marked excessive daytime sleepiness (EDS). During NCPAP treatment for 11 +/- 9 months, no traffic and near-miss accidents were reported. After NCPAP treatment, SSS decreased to 2.0 +/- 0.8, and the score of Uchida-Kraeplin test for the evaluation of working ability increased significantly. These results suggest the improvement of EDS and working ability following NCPAP treatment. We conclude that OSAS patients have the tendency of daytime sleepiness and high traffic accidents rates, and NCPAP treatment is effective to improve such problems. Language: ja
17 citations
TL;DR: Pulmonary tumor embolism shows heterogeneous manifestations such as acute and subacute cor pulmonale and diffuse alveolar damage and Clinicians should keep in mind that the heterogeneity of the disease is closely associated with the varieties of malignancies and their spread.
Abstract: To elucidate the relationship between the clinical manifestations and pathologic findings in pulmonary tumor embolism, we reviewed the autopsy and clinical records of 318 patients who died of various cancers, excluding lung cancer. Sixty-seven (21%) of the patients had at least one tumor embolus in the pulmonary arteries and 12 (3.8%) had multiple tumor emboli contributing to death. We considered that the 12 patients (6 with hepatoma, 3 with gastric cancer, and one each with colon cancer, pelvic cancer, and cervical cancer) had disease defined as pulmonary tumor embolism, and we fully analyzed these cases. Patients with hepatoma had manifestations of submassive pulmonary thromboembolism and patients with other cancers had manifestations of pulmonary microthromboembolism. The lungs of all of the 6 patients with hepatoma had both microscopic and macroscopic tumor emboli and 3 cases were accompanied by pulmonary infarction. On the other hand, the lungs of all of the remaining 6 patients had microscopic (including intracapillary) tumor emboli and 4 cases were accompanied by diffuse alveolar damage. The lung of 1 of the patients with hepatoma and 2 of the patients with other cancers also had pulmonary tumor thrombotic microangiopathy. In patients with hepatoma, the tumor emboli seemed to be derived from tumor invasion to large veins, while the tumor emboli seemed to be derived from widespread tumor invasion to lymphatic channels in the remaining patients. The authors conclude that pulmonary tumor embolism shows heterogeneous manifestations such as acute and subacute cor pulmonale and diffuse alveolar damage. Clinicians should keep in mind that the heterogeneity of the disease is closely associated with the varieties of malignancies and their spread.
17 citations
TL;DR: A 47-year-old female who had undergone hysterectomy and unilateral oophorectomy in 1975, was admitted to the authors' hospital in 1989 because chest X-ray films revealed an increase in size and number of pulmonary nodules for two years.
Abstract: A 47-year-old female, who had undergone hysterectomy and unilateral oophorectomy in 1975, was admitted to our hospital in 1989 because chest X-ray films revealed an increase in size and number of pulmonary nodules for two years. On admission, a left inguinal tumor was found and histologically it consisted of smooth muscle cells with nuclear atypia arranged in interlacing fascicles. An open-lung biopsy was performed. Pulmonary tumors revealed similar histology to the inguinal tumor. They were diagnosed as metastatic low-grade leiomyosarcoma, so-called benign metastasizing leiomyoma (BML), on the basis of location and history, reinforced by mild histologic atypia. The tumor contained a high progesterone receptor level (400 fmol/mg). Therefore, medroxyprogesterone acetate, 600 mg daily, was administered orally. At two years the pulmonary lesions had regressed. BML is a rare condition, considered to be pulmonary metastasis from low-grade leiomyosarcoma of the uterus. Measuring estrogen and progesterone receptors in lung biopy material may help determine the most appropriate therapy.
14 citations
TL;DR: A 27-year-old man suffering from incomplete type of Behçet's disease presented with swelling of the left thigh and developed recurrent hemoptysis, which decreased after treatment with colchicine and Hughes-Stovin syndrome.
Abstract: A 27-year-old man suffering from incomplete type of Behcet's disease presented with swelling of the left thigh. Venography showed obstruction of the left femoral vein by thrombus, and he was diagnosed as having deep vein thrombosis of the left femoral vein. The next year, he developed recurrent hemoptysis. Pulmonary angiography showed aneurysm and mural thrombosis of the left pulmonary artery. Fiberoptic bronchoscopy showed a reddish eminence of the left Behcet bronchus, suggestive of broncho-pulmonary artery fistula. After treatment with colchicine, the hemoptysis decreased. We report a very rare case of Behcet's disease presenting with Hughes-Stovin syndrome.
14 citations
TL;DR: A high prevalence of anti-HCV antibodies and the existence of HCV itself in the blood may suggest the possibility that HCV infection plays an important role in the pathogenesis of IPF.
Abstract: Hepatitis C virus (HCV) is a new virus discovered in 1989. Since HCV is known to cause fibrotic changes in the liver, we studied whether HCV is involved in the pathogenesis of idiopathic pulmonary fibrosis (IPF). Firstly, we assessed anti-HCV antibodies by enzyme-linked immunosorbent assay (ELISA) in the sera obtained from 66 IPF patients (46 males and 20 females; mean age +/- SEM, 61.5 +/- 10.1). We observed a significantly high prevalence of anti-HCV antibodies in IPF compared with 9,464 age-matched controls (28.8% vs 3.66%, p < 0.05). To confirm the results, recombinant immunoblotting assay (RIBA) was conducted on the 19 ELISA-positive sera, and 8 sera (12.2%) were found to be definitely positive. Secondly, we searched for HCV in the blood of IPF patients by reverse transcription-polymerase chain reaction. As preliminary data, four out of 28 cases (14.3%), all of which were pathologically diagnosed as UIP, were positive for HCV. In conclusion, although further investigation is required, a high prevalence of anti-HCV antibodies and the existence of HCV itself in the blood may suggest the possibility that HCV infection plays an important role in the pathogenesis of IPF.
13 citations
TL;DR: It is demonstrated that lower body weight and decreased exercise capacity account for the significantly lower bone mineral content of COPD patients and that COPd patients with body weight loss may be at high risk for osteoporotic fracture.
Abstract: Body weight loss is often observed in patients with chronic obstructive pulmonary disease (COPD). Bone mineral loss has also been reported in COPD, but the mechanisms are not well determined. To elucidate what factors influence on bone mineral content in COPD patients, we measured bone mineral content (BMC) by dual energy X-ray absorptiometry (DXA) (XR-26, Norland), pulmonary function, and ten minute walk distance (TMD) in Japanese elderly male patients with COPD. The subjects were 21 male patients with COPD (72.6 +/- 9.5 years) and 18 age-matched male normal individuals (66.5 +/- 9.5 years). COPD patients showed significantly (p < 0.05) lower BMC (1.82 +/- 0.33, 2.27 +/- 0.35 kg, respectively) compared with age-matched controls. BMC was significantly correlated with body weight and TMD (r = 0.71, r = 0.51, respectively). These results demonstrate that lower body weight and decreased exercise capacity account for the significantly lower bone mineral content of our COPD patients and that COPD patients with body weight loss may be at high risk for osteoporotic fracture.
13 citations
TL;DR: The results demonstrate that oral streptococci, especially "S. milleri" group, and anaerobes play a significant role as pathogens in empyema.
Abstract: The bacteriology of empyema fluid and the clinical background of 23 cases from July 1987 through July 1992 were studied. Nineteen cases were male and 4 female, with a mean age of 59.6 years (range; 33 to 84 y.o.). There were 15 cases of community-acquired infection and 8 of nosocomial infection. Acute pneumonia and/or lung abscess developed into empyema in 19 cases. Sixteen cases had associated predisposing conditions, such as diabetes, chronic bronchitis, disorders with dysphagia, and excess alcohol intake. Forty-one strains were isolated from empyema in 22 cases. The predominant organisms, in order of prevalence, were "Streptococcus milleri" group (11 strains), Peptostreptococcus spp. (6), Prevotella spp. (6), Fusobacterium spp. (5) and other viridans streptococci (3). The majority of streptococcal infections, which were primarily caused by "S. milleri" group, were mixed with anaerobes and/or aerobes/facultatives. These results demonstrate that oral streptococci, especially "S. milleri" group, and anaerobes play a significant role as pathogens in empyema.
12 citations
TL;DR: This case suggests that LST using BALF is useful for the diagnosis of drug-induced pneumonitis, and the reticular pattern in the bilateral lungs gradually resolved without administration of corticosteroids or antibiotics.
Abstract: A 66-year-old Japanese man was admitted to our hospital with fever, cough and dyspnea. He had been taking Sho-Saiko-to, a traditional Chinese medicine, for twenty days. On admission, chest X-ray examination revealed a reticular pattern in the bilateral lungs, and respiratory failure was evident. Serum levels of CRP and LDH were elevated. A differential cell count of the bronchoalveolar lavage fluid (BALF) showed that lymphocytes and eosinophils were increased. Alveolitis with lymphocyte and plasma cell infiltration was observed in a pathological specimen obtained by transbronchial lung biopsy. After all drugs had been discontinued, PaO2, serum CRP and serum LDH improved, and the reticular pattern in the bilateral lungs gradually resolved without administration of corticosteroids or antibiotics. A lymphocyte stimulation test for Sho-Saiko-to using BALF gave a positive result, although LST using blood gave a doubtful reaction. The diagnosis of Sho-Saiko-to-induced pneumonitis was made from the clinical course, laboratory findings, BALF cell analysis, pathological findings and LST using BALF. Only 13 cases of pneumonitis due to administration of traditional Chinese medical drugs have been reported. This case suggests that LST using BALF is useful for the diagnosis of drug-induced pneumonitis.
12 citations
TL;DR: To follow up patients with elevated serum tumor markers is useful for the evaluation of disease activity of pulmonary tuberculosis, as further elevation of serum tumor marker levels after antituberculous therapy may indicate the presence of cancer or deterioration of the disease.
Abstract: Serum tumor markers (CEA, SLX, CA125) were evaluated in 123 patients with active pulmonary tuberculosis. The results were as follows: Elevated serum CEA, SLX and CA125 levels were found in 16.9%, 39.5% and 44.4%, respectively, of patients with active pulmonary tuberculosis. Markedly elevated serum CA125 levels were found in some cases. On chest X-ray films, the factors associated with elevation of serum tumor marker levels were examined. Serum CEA and SLX levels were correlated with the extent of disease. Pleural effusion had no influence on serum tumor marker levels. Serum SLX levels were higher in patients without a tuberculous cavity than in those with a tuberculous cavity. After therapy with antituberculous drugs, the mean values of serum SLX and CA125 levels significantly decreased. The decrease in mean value of serum CEA levels was not significant, but in 4 of 8 cases, elevated serum CEA levels were normalized after therapy. On the other hand, two cases with increased serum CEA or SLX level died of respiratory failure. These results suggest that to follow up patients with elevated serum tumor markers is useful for the evaluation of disease activity of pulmonary tuberculosis. Further elevation of serum tumor marker levels after antituberculous therapy may indicate the presence of cancer or deterioration of the disease.
11 citations
TL;DR: Compared arterial blood gas analysis and 99mTc-MAA lung perfusion scintigraphy before and after endoscopic injection sclerotherapy in 17 cases of esophageal varices complicating liver cirrhosis, it was suggested that pulmonary embolism and/or pulmonary circulatory disturbance occurred after EIS.
Abstract: We compared arterial blood gas analysis and 99mTc-MAA lung perfusion scintigraphy before and after endoscopic injection sclerotherapy (EIS) in 17 cases of esophageal varices complicating liver cirrhosis. EIS was performed by the intra-variceal injection method with 5% ethanolamine oleate (EO) as the sclerosant agent. In blood gas analysis, the mean values of partial arterial oxygen tension (PaO2) and oxygen saturation (SaO2) were decreased, and the mean value of alveolar-arterial O2 difference (AaDO2) was increased, compared with before EIS while breathing room air. On lung perfusion scintigram, the pulmonary blood flow was markedly decreased, demonstrating hypoperfusion and/or perfusion defect, compared with before EIS in most the cases. It was suggested that pulmonary embolism and/or pulmonary circulatory disturbance occurred after EIS. It is important to note that pulmonary circulatory disturbances potentially may occur after EIS without any accompanying symptoms such as dyspnea, cough, or hemoptysis.
11 citations
TL;DR: A 74-year-old man was admitted to Keio University Hospital because of an abnormal shadow in the right upper lung field on chest roentgenogram, which revealed malignant cells, by which large cell carcinoma of the lung was diagnosed.
Abstract: A 74-year-old man was admitted to Keio University Hospital because of an abnormal shadow in the right upper lung field on chest roentgenogram. Bronchoscopic examination revealed malignant cells, by which large cell carcinoma of the lung was diagnosed. Systemic survey for metastasis disclosed an ulcerated tumor on the greater curvature of the stomach. Endoscopic examination showed an elevated submucosal tumor suggesting submucosal metastasis of lung cancer to the stomach. A review of 473 autopsies of primary lung cancer at Keio University from 1958 to 1987 showed 16 cases with gastric metastasis (3.4%). Two of 16 cases were detected clinically. Gastric metastases were proven in 15.6% of autopsy cases of large cell carcinoma of the lung. Forty-three cases of primary lung cancer with gastric metastasis were reported in the Japanese literature from 1965 to 1990. Thirteen of these cases had large cell carcinoma.
TL;DR: The clinical features of acute eosinophilic pneumonia resemble those of summer type hypersensitivity pneumonitis, and it is important to diagnose AEP on the basis of clinical symptoms, and precipitating antibody, viral titer and pathological findings.
Abstract: A 49-year-old female was admitted because of high grade fever and dyspnea. Chest roentgenogram revealed diffuse reticulo-linear shadows. Laboratory findings showed peripheral blood eosinophilia, and blood gas analysis demonstrated severe hypoxemia. A few days after admission, her symptoms and signs improved, and the abnormal shadows on the chest roentgenograms decreased without treatment. To determine the diagnosis and evaluate the pathological findings and pathogenesis, we performed open lung biopsy. Bronchoalveolar lavage at the operation revealed increased total cell count and increased markedly, number of eosinophils, and the open lung biopsy specimen showed acute interstitial pneumonia with eosinophilic infiltration. We performed a study of precipitating antibodies against fourteen kinds of fungi and environmental provocation tests, with all results being negative. We diagnosed this case as having acute eosinophilic pneumonia clinicopathologically (Allen, 1989). We reviewed 22 cases with acute eosinophilic pneumonia previously reported in Japan including our case. These 22 cases demonstrated a seasonal tendency of onset in spring and summer. Eleven of 22 cases were tested for precipitating antibodies to several fungi, 3 of which showed positive results against Trichosporon cutaneum, Trichoderma viride and Aspergillus species. The clinical features of acute eosinophilic pneumonia resemble those of summer type hypersensitivity pneumonitis. Therefore, it is important to diagnose AEP on the basis of clinical symptoms, and precipitating antibody, viral titer and pathological findings.
TL;DR: There is a certain degree of overlap between the two diseases, and the clinical features of acute eosinophilic pneumonia resemble those of summer type hypersensitivity pneumonitis.
Abstract: Two cases of acute eosinophilic pneumonia are described. The patients presented with an acute febrile illness, dry cough, severe hypoxemia and diffuse pulmonary infiltrates. Total cell count and the number of eosinophils were increased in bronchoalveolar lavage fluid. The TBLB specimen showed eosinophilic infiltration of alveolar walls and spaces. Precipitating antibodies against Trichosporon cutaneum and Trichoderma viride were noted in the patients' sera, and environmental provocation tests gave positive results. The clinical features of acute eosinophilic pneumonia resemble those of summer type hypersensitivity pneumonitis. From these results, we consider that there is a certain degree of overlap between the two diseases.
TL;DR: Measles pneumonia in previously healthy patients had a good prognosis, as the hypoxemia disappeared within 6 days in all cases, and the sarcoidosis patient showed prolonged pneumonic shadows and period of hyp oxemia.
Abstract: The clinical features, chest radiographs and computed tomographic (CT) images were evaluated in 11 cases with serologically proved adult measles complicated with pneumonia (10 were previously healthy and one had sarcoidosis). Pneumonia appeared during the rash period in all cases. Respiratory symptoms were cough (9/11), dyspnea (3/11), and hypoxemia (10/11). Pneumonia manifestations were detected in only 4 cases by chest radiograph; on the other hand, they were seen in all cases by CT scan and consisted of ground-glass opacities (73%), nodular opacities (64%) and consolidation (27%). CT seems to be a useful method to detect measles pneumonia if it is suspected. Measles pneumonia in previously healthy patients had a good prognosis, as the hypoxemia disappeared within 6 days in all cases. The sarcoidosis patient showed prolonged pneumonic shadows and period of hypoxemia. Measles pneumonia occurring in a host with cellular immunodeficiency may have a severe clinical course.
TL;DR: In this patient, emphysematous bullae progressed resulting in a pneumothorax, and lung fibrosis also developed 34 years after the diagnosis of alveolar microlithiasis, stressing that the chest roentgenographic finding of ari-bronchogram demonstrating intra-alveolar foci is an important sign in the differential diagnosis.
Abstract: The patient was a 46-year-old man who was taxi driver. He had received therapy for miliary tuberculosis from nine years old, and the diagnosis of alveolar microlithiasis was made by open lung biopsy at twelve years of age in 1956. At that time, there were no emphysematous bullae, and slight alveolar wall thickening was observed histopathologically. After a 34 year interval, he developed spontaneous pneumothorax with sudden dyspnea. Multiple emphysematous bullae were found at thoracoscopy performed to treat the pneumothorax. Arterial blood gas analysis after resolution of the pneumothorax showed hypoxia with a PO2 of 65.4 torr, and lung function tests revealed restrictive disorder. Thus, in this patient, emphysematous bullae progressed resulting in a pneumothorax, and lung fibrosis also developed 34 years after the diagnosis of alveolar microlithiasis. Alveolar microlithiasis is occasionally misdiagnosed as miliary tuberculosis. The authors stress that the chest roentgenographic finding of ari-bronchogram demonstrating intra-alveolar foci is an important sign in the differential diagnosis.
TL;DR: First, questionnaires were answered by 3,243 presumably healthy subjects who underwent regular medical checkups in four cities, and some tentative vriteria for diagnosis and for treatment are proposed.
Abstract: Questionnaires were answered by 3,243 presumably healthy subjects who underwent regular medical checkups in four cities. The prevalences of risk factors for sleep-disordered breathing (SDB) were as follows; habitual snoring was reported by 13-16%, excessive daytime sleepiness by 8-9%, insomnia by 7-13% and systemic hypertension by 5-13%. Polysomnographic studies performed on some possible SDB cases who were selected by the presence of risk factors estimated that the average prevalence of SDB in the present population would be in the range of 1.14-1.94%. Secondly, questionnaires were sent to the main hospitals and institutes involved in the management of patients with SDB, asking about diagnostic criteria, number of SDB patients, management, effectiveness of treatment, etc. The total number of patients registered at those hospitals was 2,751 in 1991. Of the 132 patients who were followed for more than six months, the efficacies of body weight loss, medications, nasal CPAP and UPPP were compared. Based on the analyses of the 279 patients examined some tentative vriteria for diagnosis and for treatment are proposed.
TL;DR: The acute bronchodilator effect of amlexanox administered orally to adult asthmatics is concluded only in AIA patients, and FEV1 was not changed after administration of either of the drugs.
Abstract: Recently, we have reported that a nebulized solution of sodium cromoglycate (SCG) (Intal), a well known antiallergic agent, has an acute bronchodilator effect in patients with aspirin-induced asthma (AIA). Amlexanox is an antiallergic agent, with a structure similar to that of SCG. Therefore, we investigated the acute bronchodilator effect of amlexanox administered orally to adult asthmatics, focusing on a comparison between AIA and non-AIA patients. Fifteen patients participated, 8 having AIA and 7 non-AIA. After performing spirometry during remission, they were administered either amlexanox or placebo using a randomized double-blind protocol. Spirometry was then performed at 30, 60, 90 min, 2 h, and 3 h after administration. The placebo used was lactose. In the AIA group, FEV1 was significantly improved after administration of amlexanox. However, FEV1 was significantly decreased after placebo administration. On the other hand, in the non-AIA group, FEV1 was not changed after administration of either of the drugs. From these results, we conclude that amlexanox has an acute bronchodilator effect only in AIA patients.
TL;DR: It can be concluded that the lymphocyte stimulation test may be useful in the detection of the causes of drug induced allergies in patients undergoing drug therapy for tuberculosis.
Abstract: We clinically investigated 19 cases of antituberculous drug-induced allergy. The results of the challenge tests were positive in 30 out of the 55 drugs tested. The results of the lymphocyte stimulation tests were positive in 19 out of the 55 drugs tested. In 84.2% of the cases with positive lymphocyte stimulation test findings, the challenge test was also positive. It can be concluded from these results that the lymphocyte stimulation test may be useful in the detection of the causes of drug induced allergies in patients undergoing drug therapy for tuberculosis.
TL;DR: It is considered that asthmatics with late onset and severe symptoms have a high risk for CSS, and poor control of asthmatic symptoms may contribute to the onset of vasculitis.
Abstract: We studied the clinical features and prognosis of 11 patients with Churg-Strauss syndrome (CSS). Subjects included 1 man and 10 women with a mean age of 56.3 years. All subjects had a history of bronchial asthma prior to the onset of CSS. It was noted that the age of onset of bronchial asthma was high, and most of the patients had suffered from frequent and severe asthmatic attacks during the periods preceding the vasculitis. Skin tests and IgE RAST revealed that less than half of the subjects were atopic. Therefore it is considered that asthmatics with late onset and severe symptoms have a high risk for CSS, and poor control of asthmatic symptoms may contribute to the onset of the vasculitis. Eleven of 12 cases including 1 patient with a relapse were treated with PSL alone (9 cases) or PSL plus cyclophosphamide (2 cases). Three patients died of heart failure or central nerve involvement. Vasculitis was ameliorated in the other cases (75%). Seven patients received maintenance therapy with low-dose of PSL (5 cases) or cyclophosphamide (2 case). None suffered from relapse of vasculitis during maintenance therapy. Discontinuation of therapy in five cases resulted in a relapse in only one case 62 months after the cessation of low-dose PSL. Although maintenance therapy appears to be useful in some CSS patients, the significance and indications for maintenance therapy should be further clarified.
TL;DR: A 50-year-old male spray paint worker was admitted with non-productive cough and dyspnea on exertion, andBronchoconstriction may cause worsening of respiratory symptoms in patients with hypersensitivity pneumonitis induced by isocyanates.
Abstract: A 50-year-old male spray paint worker was admitted with non-productive cough and dyspnea on exertion. Chest X-ray and chest CT showed diffuse interstitial shadows in the bilateral lung fields. After admission, the symptoms and chest X-ray findings improved over several days, and he was followed as an outpatient. He then developed nocturnal dyspnea with wheezing and dry cough every day. About two months later, chest X-ray showed more severe diffuse interstitial shadows which did not disappear after admission. Bronchoalveolar lavage and transbronchial lung biopsy revealed allergic exudative interstitial pneumonia, and he was treated with steroid therapy. Paint contains toluene diisocyanate, and challenge test to toluene diisocyanate was positive. In the early course, this case presented with bronchoconstriction; bronchial reversibility and bronchial hyperresponsiveness to methacholine were positive. Bronchoconstriction may cause worsening of respiratory symptoms in patients with hypersensitivity pneumonitis induced by isocyanates.
TL;DR: EM clinically improved not only the lower airway symptoms, but also the nasal symptoms, and disorder of mucociliary transport function was present in patients with SBS, and EM therapy improved this function.
Abstract: The effect of erythromycin (EM) on mucociliary transport function assessed by saccharin test and clinical symptoms were studied in 19 patients with sinobronchial syndrome (SBS). Before treatment with EM, the mean nasal clearance time (NCT) of SBS patients was 51.9 +/- 40.5 (SD) min, which was significantly (p < 0.01) longer than that of control subjects (12.4 +/- 5.3 min). After 4-week treatment with oral EM (600 mg/day), NCT of SBS patients significantly (p < 0.01) improved (29.2 +/- 34.2 min). In 11 of 19 SBS patients, bacteria from sputum culture disappeared after EM therapy. Frequency of cough and volume of sputum were significantly (p < 0.05) decreased by EM therapy. Nasal symptoms (such as nasal obstruction and rhinorrhea) were also significantly (p < 0.05) improved by EM therapy. These findings suggested that disorder of mucociliary transport function was present in patients with SBS, and EM therapy improved this function. EM clinically improved not only the lower airway symptoms, but also the nasal symptoms.
TL;DR: A 58-year-old woman was admitted with cough, dyspnea on effort and diffuse micronodular and patchy shadows on her chest roentgenograms, but pulmonary hemorrhage was thought to be secondary to SLE, since the renal biopsy showed lupus nephritis.
Abstract: A 58-year-old woman was admitted with cough, dyspnea on effort and diffuse micronodular and patchy shadows on her chest roentgenograms. Two weeks later, acute pulmonary hemorrhage developed with low levels of complement and positive immune complexes. She was diagnosed as having systemic lupus erythematosus (SLE) with positive anti-nuclear antibody, positive anti-DNA antibody, biologically false positive Wassermann reaction, auto-immune hemolytic anemia and photosensitive dermatoses. In addition, anti-glomerular basement membrane antibody (anti-GBM antibody) was positive in serum, but pulmonary hemorrhage was thought to be secondary to SLE, since the renal biopsy showed lupus nephritis. Cases of SLE with positive anti-GBM antibody are seldom confirmed. It was assumed that the basement membrane of the lung or kidney was damaged first by interstitial pneumonitis due to SLE or lupus nephritis, basement membranes antigens were exposed, with secondary production of anti-GBM antibody.
TL;DR: Combination therapy of intravenous administration of 100,000 units of urinastatin and intracavitary injection of AMPH resulted in complete disappearance of the fungus ball on chest CT scan.
Abstract: A 57-year-old man with pulmonary tuberculosis underwent left upper lobectomy in 1984. In 1987, chest X-ray showed a fungus ball, and Aspergillus species was isolated from sputum. He was treated by intracavitary injection of amphotericin B (AMPH) in June, 1992. However, no change was observed in the chest CT scan after a total dose of 1,000 mg of AMPH. Combination therapy of intravenous administration of 100,000 units of urinastatin and intracavitary injection of AMPH resulted in complete disappearance of the fungus ball on chest CT scan. This report describes case of pulmonary aspergilloma successfully treated with the combination of AMPH and urinastatin.
TL;DR: Findings indicate that EM is effective for DPB even in patients with chronic respiratory failure, and FEV1 was significantly increased in pulmonary function tests.
Abstract: We studied the effects of erythromycin (EM) in diffuse panbronchiolitis (DPB) with chronic respiratory failure. Seventeen patients with DPB or sinobronchial syndrome receiving home oxygen therapy (HOT) were treated with EM of 400-600 mg/day for twelve months. Five patients discontinued HOT, and hypoxemia was improved in five other patients. Clinical effects were evident at one month after the start of EM administration, and a stable state was achieved after six months of EM therapy. FEV1 was significantly increased in pulmonary function tests. Factors which influenced the effects of EM included the period between onset of clinical symptoms and commencement of HOT and/or between commencement of HOT and administration of EM. EM was effective for patients with obstructive, but not constrictive impairment in pulmonary function tests. These findings indicate that EM is effective for DPB even in patients with chronic respiratory failure.
TL;DR: This is the first report of interferon-alpha-induced pulmonary injury in Japan and marked accumulation of macrophages is reported.
Abstract: We report a case of interferon-alpha-induced pneumonitis. A 61-year-old man was diagnosed as having recurrence of renal cell carcinoma and treated with 3 x 10(6) unit of interferon-alpha daily for 8 weeks. On the 55th injection, he presented with a high fever and mild dyspnea, and his chest CT films revealed diffuse reticulonodular shadows in both lung fields. We suspected interstitial pneumonitis due to interferon-alpha, and started steroid therapy. He showed rapid improvement of symptoms and diffusing capacity, and the pulmonary infiltrates in his chest CT were markedly reduced. Transbronchial lung biopsy (TBLB) revealed slightly thickened alveolar walls and small granulomatous-like lesions. These granulomatous-like lesions showed marked accumulation of macrophages. To our knowledge, this is the first report of interferon-alpha-induced pulmonary injury in Japan.
TL;DR: A 61-year-old female admitted to the authors' hospital because of cough, hemosputum and right chest pain was concluded that the domestic insecticide containing mineral oil had resulted in exogenous lipoid pneumonia.
Abstract: A 61-year-old female was admitted to our hospital because of cough, hemosputum and right chest pain The P-A and L-R chest films revealed focal consolidation in the right upper filed and mass-like shadow in the right S3 Transbronchial lung biopsy specimens showed collections of lipid-laden macrophages The lipid material of macrophages in broncholaveolar lavage fluid was stained yellow-orange with Sudan IV The patient had no difficulty in swallowing and had no history of regular use of oily drugs Fiberoptic bronchoscopy and chest CT showed no obstruction of bronchi She had used much domestic insecticide with the doors closed before going to bed every summer and autumn for 10 years We concluded that the domestic insecticide containing mineral oil had resulted in exogenous lipoid pneumonia Her symptoms and abnormal shadows in chest X-ray film disappeared soon after antimicrobial chemotherapy was started She is now healthy without recurrence
TL;DR: A 64-year-old man was admitted to the authors' hospital with complaints of chest pain on Sep. 26, 1991 but coronary angiography revealed no abnormal findings in the right and left coronary arteries, and no elevation of SGOT, LDH or CPK was found.
Abstract: A 64-year-old man was admitted to our hospital with complaints of chest pain on Sep. 26, 1991. ECG revealed myocardial infarction-like ST-elevation in II, III, aVF, V4, V5, and V6 but coronary angiography revealed no abnormal findings in the right and left coronary arteries, and no elevation of SGOT, LDH or CPK was found. Chest CT scan, UCG and chest MRI revealed a tumor invading into myocardium in the left cardiophrenic angle. Myocardial scintigraphy revealed a cold area in the inferior wall. Histologically, the tumor was squamous cell cancer. In spite of treatment, the patient died due to heart failure on Feb. 8, 1992. Myocardial metastasis showing a myocardial infarction-like ECG has been rarely reported.
TL;DR: A 65-year-old man with a history of a common cold who was referred to the authors' division for further evaluation of an abnormality on chest X-ray film was diagnosed with an inflammatory pseudotumor, a plasma cell granuloma (PCG), and successfully treated nonsurgically with steroid therapy.
Abstract: A 65-year-old man with a history of a common cold two months earlier was referred to our division for further evaluation of an abnormality on chest X-ray film. Transbronchial lung biopsy findings revealed an inflammatory pseudotumor, a plasma cell granuloma (PCG). The pulmonary nodule disappeared completely six weeks after steroid therapy. To our knowledge, all PCG cases to date have been surgically resected. Therefore, this case of PCG diagnosed by transbronchial lung biopsy and successfully treated nonsurgically with steroid therapy is worthy of note.
TL;DR: Examination by thoracoscopy using flexible fiberoptic bronchoscope may be very useful for the diagnosis of tuberculous pleuritis in patients with pleural effusion, according to reported method.
Abstract: Examination by thoracoscopy, using flexible fiberoptic bronchoscope, was performed in 43 patients with pleural effusion according to our reported method. In these patients, 14 cases were diagnosed as tuberculous pleuritis. These 14 cases were investigated with respect to clinical and thoracoscopic findings. Their mean age was 38.1 years, and 11 cases were younger than 50 years old (78.5%). The male:female ratio was 2/1. Clinical symptoms recognised were fever (100%), cough (64.2%), chest oppression (50%) and sputum (35.7%). In 5 cases, gastrointestinal symptoms were recognized such as vomiting, abdominal pain, and diarrhea. Tuberculin reaction was positive in all patients with tuberculous pleuritis on admission. With respect to the thoracoscopic findings of tuberculous pleuritis, yellow-white miliary granulomas were observed on the parietal pleura in 12 cases (85.7%), and this characteristic finding was especially observed at the apex. Biopsy specimens, obtained from these miliary granulomas on the parietal pleura showed histological findings of tubercles. In the other 2 cases, generalized reddening of the entire parietal pleura was observed, with no yellow-white miliary granulomas. Biopsy specimens obtained from the reddened lesions on the parietal pleura showed histological findings of tubercles, and these 2 cases were also diagnosed as tuberculous pleuritis. These results indicate that this method may be very useful for the diagnosis of tuberculous pleuritis in patients with pleural effusion.